Scottish Bacterial STI
Reference Laboratory
y
(SBSTIRL)
Kirstine Eastick PhD
FRCPath
Director and Consultant
Clinical Scientist
Who we are
Kirstine Eastick - Director
 A Paddy
P dd Gibb - Deputy
D
t Director
Di
t and
d
Medical Adviser
 Janis Shade - Administrator (0.8
wte))
 John Anderson - SBMS
 Brian Malloy - SBMS
 Alison Fleming - SBMS (0.5 wte)

Episodes of gonorrhoea
submitted to SBSTIRL: 1992‐2012
Total
Male
Female
2500
Episodes
2000
1500
1000
500
0
92
19
94
19
96
19
98
19
00
20
02
20
Year
04
20
06
20
08
20
10
20
12
20
What we do [1]

Neisseria gonorrhoeae cultures
950 in
i 2012
 ID (Gram, oxidase, Phadebact, sugars)
 Susceptibilities (agar dilution and Etest)

• penicillin, tetracycline, ciprofloxacin,
azithromycin,
ith
i spectinomycin,
ti
i cefixime,
fi i
ceftriaxone
• nitrocefin

NG-MAST
What we do [2]

GC NAAT confirmation
2280 in 2012
 In-house realtime PCR targeting
g
gp
porA,,
pgi1, internal control
 NG
NG-MAST
MAST

• where there is no isolate for the episode
• where GC NAAT is confirmed in the
referring laboratory
What we do [3]
LGV PCR on C. trachomatis-positive
samples
l ffrom patients
ti t att risk
i k
 T. pa
pallidum
du PCR
C (c
(charged)
a ged)

What we don’t do

Syphilis serology
NG-MAST
Neisseria gonorrhoeae multi-antigen
sequence typing
 Sequence 2 highly-variable alleles,
porB,
B tbpB
b B
 Each type
yp varies by
y 1 nucleotide
 Objective, international, web-based
system
 >8000 types in database

0
Sequence Type
85 STs
s
22 STs
s
1868
8
5867
7
6875
5
3193
3
6341
1
6838
8
7653
3
2616
6
3378
8
3520
0
4792
2
6293
3
1034
4
6299
9
5119
9
6216
6
2487
7
1222
2
3920
0
3916
6
4820
0
25
5
384
4
3149
9
2400
0
2
28
8
4758
8
2992
2
1582
2
225
5
273
3
995
5
51
1
N
Number of E
Episodes
Sequence type distribution by occurrence ‐
J
January ‐
J
June 2012
2012
100
90
80
70
60
50
40
30
20
10
What next? [1]

AMR
Decreased susceptibility to
cephalosporins likely in next 5-10 years
 Surveillance crucial
 NG
NG-MAST
MAST on NAAT samples will help
 New antibiotics?
 Resistance
R i t
mechanisms?
h i
?

What next? [2]

Next-generation sequencing
Streamline NG-MAST?
 WGS

• Medicolegal work
• Understanding
gp
pathogenicity
g
y and
epidemiology
• Antimicrobial resistance